EMT? WEMT? WFR? Just my insight on it all (and hi by the way ;)

EMSLaw

Legal Beagle
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One note though is the WMA (Wilderness Medical Associates) does a WEMT that certifies to the level of EMT-I85 in one month. If I were going to get my EMT from a wilderness medicine school i would choose that one just to be a EMT-I.

I was in what you might call the beta group for that class - in other words, I took the first ever class, which just ended recently.

I'll probably get around to posting a review with my experiences and thoughts at some point. If anyone has any specific questions, though, I'll gladly try to answer, or you can PM me.
 

Nelg

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Ohh wow, super interested in all this, but I'm still a greenhorn freshly minted EMT-B working on his NREMT. Chalk that down on my "to learn later" list :D
 

khorosho

Forum Ride Along
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Nobody has mentioned Remote Medical International in WA state. WEMT-B plus some invasive skills I'm told are allowed only in the darkest jungles or far out at sea. Expensive, intensive, residential. Check out the digs. How to afford? Hey, most of us have two functioning kidneys; you can get by with just one, right?:p No, I have no vested interest in them or their program. Looks top notch with bright instructors, though. 200 hours.
 

AVPU

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RMI has been mentioned in several posts on here. I took their WEMT / MPIC class last year. High quality instructors, lots of hands-on, taught in a remote setting, and we managed to have some fun. Expensive, yes. Worth it? Depends on what you want to do afterward. I was looking for a career change and to get into EMS, so this was good (an intensive month-long, full-time program). I would caution you though on their claim of a 90% first-time pass rate of the written NREMT. I'm not saying it's false, but 1. the class focuses on Wilderness scenarios, as it should, but that doesn't exactly prepare you for the urban EMT-style test; and 2. upon hearing of such a high pass rate, I didn't study for the national exam nearly as much as I should have. It's a false security (which I take responsibility for....making the decision not to study hard). Consequently I failed the written NREMT the first time (but passed on the second). I had a few classmates with similar experiences.

Just some words of caution. Overall, in my research and from what I've heard, RMI is one of the best outdoor safety schools around.
 
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khorosho

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Yes, seems I brought up RMI before. Someone replied he knew a handful of folks who went there, also mentioned western WA saturated with EMT-B's, not enough work. I had expected to have time to study for NR, as the written (computerized) test isn't included in the course. Can't tell you why I'm fixated on RMI; could it be the website? Close runners-up for me are Landmark in NC and a place in NH whose name slips by. Also Acadia /NEMSA in Lousiana, but they offer standard urban course.
 

wildrivermedic

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I would first argue that most EMT-Bs, WFAs, WFRs, and WEMTs don't have a good grasp on anatomy, physiology, nor pathophyisiology of disease.

This seems generally true, for someone just out of class. However, I've found that many (not all!) WFRs and WEMTs have the motivation to continue their education after the class ends. Some of this motivation comes from choosing to be responsible for other people's health on backcountry trips and such... the quality of care is really up to you.

For me that means reading everything I can find, keeping up on the "common and simple" treatments I might do in the field, and questioning my ambulance-based ALS partners on what I can do to prep the patient in the worst case scenarios when I would have to call them. It's rewarding to me to try to clear up contradictions between what I was taught (WMI WEMT), what I learn now, and what I teach (a couple different WFA courses). For instance, active rewarming for hypothermia in the absence of an AED... understanding why not involves learning some physiology.

My experience with WMI was great -- the class is short but very intensive, 24-hours a day towards the end when you're assessing patients in your dreams! I took it a year ago, have been on a remote rural volunteer crew since then, teach WFA, coordinate medical stuff for an outdoor school, and (fingers crossed) hope to sign on as a fireline EMT this season. I coulda done all of this without the "W", but it has helped.

LucidResq: an EMT with wilderness experience will probably trump a WFR in the hiring process... you sound more than qualified! The issue is, as stated, almost purely legal. The flimsy legal covering for my being able to reduce dislocations, clear c-spine, or give a kid Benadryl is the little card that said I was trained to do so, and strict adherence to that training. If you work for an organization that has written protocol (the industry standard) signed off on by an MD, that should cover you.
 

Outworld

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Hey, thanks for your post! Very interesting read as to your views and some of the information that's out there.

I will say that being a medic in the woods has it's advantages. I would first argue that most EMT-Bs, WFAs, WFRs, and WEMTs don't have a good grasp on anatomy, physiology, nor pathophyisiology of disease. The extended education of the advanced provider will help in diagnosing conditions in the wilderness and making good decisions, even if we don't have all of the fancy tools from the ambulance.

In addition to a better assessment, I would also argue that advanced level practitioners could provide IM/IN analgesia and medications that are often needed for other wilderness emergencies -- such as anaphylaxis, asthma, HAPE/HACE, etc.

I understand that walking out into the woods today with no equipment on me, I couldn't provide more treatment than a WFR. However, I believe that my experience and education would help with decision making and overall patient management. Also, if you have a duty to act in a rural or wilderness medical capacity, you should be prepared with the necessary tools to do your job effectively - including medications necessary for common wilderness emergencies.

I agree with RedCross EMT. There is a lot of discussion about the 'cert', when in my opinion the education and the foundation knowledge is the worthy part. Some companies offer an 'In the can' WEMT or WFR, and others offer the cert but the focus is on the experience gained during the course. I have heard mixed review about all the US companies, but it seems that NOLS has the philosophy that aligns with most of the goals that I see discussed here, and that is the ability to actually manage a medical incident in the remote setting. This requires critical thinking, some McGyver skills,(ability to improvise) leadership skills, problem solving and so on.
There is a lot that we can do with minimal supplies. Pain can be managed without medication, the ability to do a thorough exam and make decisions about transport and treatment, when to walk vs carry, when to take your time vs when to make haste, dealing with boo boo issues that may otherwise end the patients participation (tooth abcess and foreign body in the eye are 2 examples that come to mind), managing a jacked airway with improvised devices, assessing and treating in the rain and the dark and the mud and.... I think that the NOLS philosophy is more about the journey than the cert, so for a US company they may be a good choice. I have heard from many of my students that many WMA are 'in the can' classes, and I no longer recommend them.
There are a couple of smaler companies out there that offer challenging scenarios in challenging places, out of the country. Do a search for Remote or Austere medicine or rescue rather than Wilderness Med. You might find some interesting options.
In short, my advice would be to seek out the training that leads you into a flexible, critical thinking mindset in the Remote setting. Read the medical texts, not just the 'wilderness books, read the expedition books, the travel narratives, pick brains, play the 'what if' game....The cert is just the paper on the wall, the experience is the goal..
 

Cake

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This is a great thread! I've wondered a lot about what's been discussed, and the best way to tackle these options post EMT-B cert. (Just passed my final practical last night)

I took my EMT class through Red Cross, so other than my ride alongs, I have no fire/urban experience. Maybe that'll be beneficial to me if I decide to pursue the wilderness path, which is something that I really want to be involved in, someway, somehow..

It seems like that it can never hurt to get more education, although the NOLS folks at the live chat warned me that their WFR class would not only upgrade my EMT to WEMT, but it would overlap, and there was a slight concern on their end about that. Isn't the whole idea to learn how to do the same thing 2 different ways?? WUMP is cheaper and shorter, but I'm wondering since I'm pretty cherry, that I should consider taking the WFR class.
 

Outworld

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This is a great thread! I've wondered a lot about what's been discussed, and the best way to tackle these options post EMT-B cert. (Just passed my final practical last night)

I took my EMT class through Red Cross, so other than my ride alongs, I have no fire/urban experience. Maybe that'll be beneficial to me if I decide to pursue the wilderness path, which is something that I really want to be involved in, someway, somehow..

It seems like that it can never hurt to get more education, although the NOLS folks at the live chat warned me that their WFR class would not only upgrade my EMT to WEMT, but it would overlap, and there was a slight concern on their end about that. Isn't the whole idea to learn how to do the same thing 2 different ways?? WUMP is cheaper and shorter, but I'm wondering since I'm pretty cherry, that I should consider taking the WFR class.

Because you already have the EMT, you want most of your training to be devoted to long-term medical care, the leaders role in managing wilderness emergencies and SAR Ops. You want a course that will teach you to improvise and adapt, with little or no medical supplies. A dislocated shoulder is easy in the urban area, but what if your in vertical country and the difference between a walk out and a full blown rescue is whether you can reduce the shoulder?

You should find a course that teaches you how to take care of problems that are not street EMS. Infections, diarrhea, belly pain, rashes, owies, foreign bodies in the eye, ingrown toenails, dental problems, sprains and strains are more common in remote medicine than acute trauma. You should be able to clear a C-Spine, reduce a dislocation, treat asthma, allergies, HAPE and so on.

Spend some time speaking with the Instructors, or former students. Don't ne afraid to pester the company that is offering the courses. And remember, you will find a wealth of information in classes that teach you remote and critical thinking skills, so find that Rescue class, the survival class, the route finding class, all these things sharpen your critical thinking, problem solving skills..
 

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